This paper offers an investigation of the portrayal of depression
in magazines whose audience is primarily North American males of young
middle ages ranging between medians of 37 and 42.5. It is based on a
content analysis of articles indexed under the topic of depression from
2000-2007 in Esquire, Men's Health and Sports Illustrated
magazines. Findings suggest that depression in men's magazines is
encapsulated in stereotypical male discourses of success at work,
ignorance of feelings, and reluctance to seek help. Violence is another,
although less prevalent theme. Depression is described as largely as
having biochemical and/or genetic cause. A few articles mention the
possible effects of the socio-economic and gendered experiences of
maleness or masculinity. The possible theoretical explanations of this
portrayal are discussed.

Keywords: depression, magazines, men, middle age men, young men

**********

The purpose of this paper is to describe and analyze the portrayal
of depression in three popular mass media magazines directed
specifically towards young middle-aged men, Sports Illustrated, Esquire
and Men's Health, during the years 2000-2007.

Depression is the largest overall cause of nonfatal disease
internationally. About 12 percent of all years lived include depressed
years (Ustun, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004).
Approximately 9.5 percent of the population in the United States 18
years of age and over were diagnosed with a mood disorder in 2006 (NIMH,
No. 06-4584). Gender differences in the incidence of depression in
adults at a ratio of approximately 2:1 (female to male) have been
documented for the past thirty years or so in the United States, Canada
and the United Kingdom (The Daily, September 3, 2003; Goodwin, Gould,
Blanko, & Olfson, 2001; Kornstein & Schatzberg, 2000; Weissman
& Klerman, 1977).

There are a variety of ways of understanding and explaining the
differences in the rates of depression among men and women (Simon &
Nath, 2004). Normative theory proposes that emotional expression results
from specific socio-cultural contexts (Hochschild, 1975; Thoits, 1989).
Men and women inhabit different but overlapping gender cultures with
corresponding norms for behavior, feelings and attitudes. Women's
culture encourages both the experience and the expression of emotion
more than does that of men (Simon & Nath, 2004). Women are expected
to be more likely to express sadness and men are expected to be more
likely to express anger (Simon & Nath, 2004; Umberson, Anderson,
Williams, &Chen, 2003). In fact, aggression is one of the more
acceptable ways for men to express unhappiness and to demonstrate
masculinity in Western societies (Umberson et al.).

Kemper (1978, 1981,1990, 1991) argues that the
"normative" expression of emotion corresponds to social
position. Thus, happiness is more likely to be experienced by those with
more power and status, and unhappiness is more common among those who
are relatively powerless and have lower social status. The relatively
higher social status of men, according to this theory and the research
confirming it, explains the lower rates of depression among men.

Along with these explanations of gender differences in occurrence
of depression are those that focus on the differential power of
medicalization among men as compared to women. Medicalization is thought
to be particularly problematic for women because medicine's control
of women was believed to be central to the logic and growth of its power
(Riska, 2003). Through medicalization, it has been argued, a great deal
of women's lives and "ordinary physical and psychological
functions" including moods (Reissman, 2003[ 1983], p. 57) have
become defined as pathological. Gendered medicalization has also led to
differences in help-seeking behaviors, so that women have been more
likely to seek medical assistance than men (Nazroo, 2001). More
recently, however, the growing rates of ADHD among boys and the
diagnosis of erectile dysfunction, balding and aging among men, point to
an increasing medicalization of masculinity (Rosenfeld & Faircloth,
2006).

Artifact explanations for gender differences in depression rates
point to the biases resulting from different definitions and
measurements of depression (Nazroo, 2001; Sigmon et al., 2005). Thus,
the meaning of the experience of depression appears to differ for men
and women (Laitinen & Ettorre, 2004). Men tend to "act
out" and express their sadness and frustration through anger and
opposition to others, while women "act in" and express anger
towards themselves and become depressed (Kilmartin, 2005; Laitinen &
Ettorre, 2004; Nazroo, 2001). Women are also more able or likely to
notice and identify feelings of sadness than men. Doctors are more
likely to identify the same symptoms as depression in women and
something else in men (Curry & O'Brien, 2006).

Parallel feelings of sadness and despair that lead women to be
diagnosed with depression appear to lead men to commit suicide 3-4 times
more often than women (Hawton, 2000; Moscicki, 1995). Depression appears
to contribute to 50-90 percent of suicides (Kochanek, Murphy, Anderson
& Scott, 2004; Moller-Leimkuhler, 2003). Likely in response to
feelings akin to depression, men abuse alcohol and drugs at least twice
as frequently as women (Sue & Chu, 2003) and commit the majority
(about 86 percent) of violent crimes (Greenfield & Snell, 1999).
Male domestic violence may be connected to the tendency for men to
repress emotion (Umberson et al., 2003).

The influences of hegemonic masculinities and femininities may also
help explain gender differences in emotion. Some men's studies
scholars have argued that the characteristics of depression, as
described in the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM), are not compatible with
the demands of hegemonic masculinities (Connell & Messerschmidt,
2005; Warren, 1983). It is difficult for men to admit to symptoms such
as depressed mood, tiredness and a lack of energy because these
experiences lie outside of the acceptable boundaries of socially
desirable masculinities (Connell & Messerschmidt; Emslie, Ridge,
Ziebland, & Hunt, 2006; Kilmartin, 2005). This is reinforced by the
cultural assumption that part of being a man is to be not feminine and
to eschew feminine traits (Brannon, 1985), including emotional and other
vulnerabilities (Emslie et al.). Thus, denying their own depression is
fundamental to men for the demonstration of "masculinity"
(Courtenay, 2000; Smith, 1999). Some scholars have found that most men
were willing to admit to being stressed but not depressed (O'Brien,
Hunt & Hart, 2005). Others have noted that recovery from depression
for most men involved the re-establishment of hegemonic masculinity
through the use of such narratives as "being one of the boys,"
"re-establishing control" and demonstrating
"responsibility to others" (Emslie et al., p. 2246).

One contribution to understanding the diagnosis of depression is
study of mass media. The media's portrayal of mental illness has
been the subject of a substantial amount of study (Allen & Nairn,
1997; Beveridge, 1996; Diefenbach, 1997; Francis et al., 2004; Gattuso,
Fullagar, & Young, 2005; Hazelton, 1997; Nairn, 1999; Nairn,
Coverale & Claasen, 2001; Olstead, 2002; Parslow, 2002; Philo, ed.,
1996; Rose, 1998; Rowe, Tilbury, Rapley & O'Ferrall, 2003;
Sieff, 2003; Signorelli, 1989; Ward, 1997). While there has been a great
deal of research on mental illness in the media there has been less on
the specific case of the most common diagnosis, depression (Rowe et
al.).

One study, Rowe et al. (2003), found that the focus in depression
stories was not on the potential for crime and violence against others
but on the costs of the illness to the one who suffers. Blum and
Stracuzzi (2004) found that depression was portrayed as primarily a
women's disease. Metzl and Angel (2004) found an increase in
gendered non-medical or non-DSM referents as symptoms of depression
after the introduction of the new and highly popular selective serotonin
reuptake inhibitor (SSRI) drugs. They observed that stories about SSRI
anti-depressants medicalized women's lives and bodies by broadening
the types of female behaviours that required treatment with
anti-depressants. Men were seldom described as depressed, and when they
were it was in terms that were restrictive and narrowly associated in
published medical (DSM) terms.

The Study

Data Collection and Analysis

This study was based on a search of all full-text articles (without
graphics) indexed by the term "depression" in The Readers
Guide to Periodical Literature for 2000-2007 in three English-language
magazines directed primarily towards men, Sports Illustrated, Esquire
and Men's Health, all published in the United States. Magazine
stories were selected as data because magazines are circulated widely
and are often read more than once. In this way, print media may at times
be more permanent than television or radio reports. The magazines were
selected as representing three of the most widely circulating magazines
available in North America. Table 1 describes the socio-demographic
characteristics of the readership of Sports Illustrated, Esquire, and
Men's Health.

The years 2000-2007 were selected in order to provide enough data
over a long enough period of time to avoid the bias of the selection of
one year only when a particular event, such as the announcement of an
instance of depression in a sports or other male celebrity, might have
occurred. There were nine articles in Sports Illustrated, six in
Esquire, and fifteen in Men's Health indexed by the topic
"depression" during the period.

Initially all articles were read by the author to categorize them
for manifest content, as pertaining to (psychological) depression, and
thus worthy of sample inclusion. Subsequently, all articles were reread
and summarized as to topics of discussion and (1) types of attitude
toward depression, (2) its causes and treatments, (3) the
characteristics of the people who were featured in the articles, and (4)
any other significant subthemes (Berg, 1989; Clarke & Gawley, 2009;
Neuman, 2000). Subsequent readings were for selective coding to identify
and label the major emerging themes and to select illustrative
quotations.

Findings

Attitudes towards Depression: Men's Reluctant and Invisible
Feelings

The media stories reinforced the idea that most men are reluctant
to acknowledge they have feelings, especially "bad" feelings.
The following is a typical expression of this theme: "Someone once
said that if you ask a man how he feels, he looks inside and sees a deep
void. Someone else once said that men are numb from the neck to the
crotch. Catchy phrases, but not really true. Men have feelings. We just
ignore them" (MH1, 98). (2) Acknowledging feelings is portrayed as
weakness even as men may be encouraged not to think that way. Articles
suggest that most "normal" men do think of feelings as
unacceptable. For instance: "You have depression. Shoot.
That's not depression. That's weakness. That's how the
thinking goes" (SI9, 73). At times, men are described as knowing
they have feelings but believing that, as men, they ought not to share
them with anyone else. For example: "Most of us feel guilty about
everything. We don't want to tell anyone our negative thoughts
because they are shameful, or wrong or cruel" (MH1,98).

Men are portrayed as active and in control and not subject to
vulnerabilities and emotional sensitivities even in the face of
depression. Note the following two examples. In answer to the question,
how do you deal with depression one man responded: "Change my mode
of thinking. Instead of dwelling on something in the past that's
beyond my control or something in the future that I can't predict,
now I try to live in the moment" (102, 21). Another male is quoted
as saying: "I hit the gym. It cheers me up knowing that I can do
something most people can't do, like run a few miles or lift
weights" (102, 21).

Humor is sometimes used to make the point that men don't want
to acknowledge feelings: "Guys love couches--as long as
there's a game on. But put a therapist in the room instead of a
TV?" Considering how most men feel about weakness, the subject of
mental health can be even touchier than most physical maladies. For
instance: "I don't have time to contemplate my life on a
therapists couch, or exercise. I pop a pill every morning, and
that's all I need" (104, 74).

Sometimes the point about men's lack of attention to feelings
is made through a contrast with women, as it is in the following
statements. "Women are more likely to acknowledge depression and
seek treatment for it, but men are just as likely to have it"
(MH2,153). "Sixty-six percent of those in the United States with
major depression are still undiagnosed, and most of them are men"
(MH2,153).

Causes and Treatments: A Real Disease

Some articles stressed that there were biological roots to
depression and that it was a real disease. "It helped him realize
that his funk was not some embarrassing defect but a bona fide disease.
He went to the doctor and got a prescription for anti-depressants. The
difference is night and day, he says "I feel better. My life has
been renewed. Like a clogged artery or liver disease, your brain
requires professional attention" (106, 62). Depression is portrayed
as "a real disease that must be fought as tenaciously as cancer or
heart disease" (MH2, 153).

Various pharmaceutical interventions are recommended for treating
this 'real disease' as in the following two quotations,
"A shrink prescribed an antidepressant/sleep inducer called
Trazodone, and it got me through the dark nights" (100, 155). Shea
took EffexorXR." Right away" says Shea, "I noticed a big
change in achieving general day to day happiness" (SI9, 74).

There are, however, a few suggestions that people can control
depression themselves offered at the same time. Note the following
"the doctor himself though has never suffered from depression
because he places little spots of joy in his life. Right now it's
his grandchildren" (MH2, 153). 'Natural' or non-medical
remedies are recommended as in the next quotation. "Fish oil
"helps brain cells communicate better, increases the brain's
sensitivity to serotonin, a hormone that produces feelings of
happiness" (103, 129).

Characteristic of Men Who are Depressed: Success in Work or Sports.

When men with depression are described they are usually very
successful at work or in sport. For example, one article in claiming
that men do get depressed emphasizes this fact by indicating that the
types of people include "CEOs and Nobel prize winners" (MH2,
151). Similarly, the following quotation emphasizes first the
credentials of the medical expert and then reinforces the notion that it
is successful men who get depressed. "Dr. J Raymond de Paulo Jr. M.
D. Chairman of the department of Psychiatry at the Johns Hopkins
University School of Medicine has treated nearly 8,000 people with
depressive disorders, including CEOs and Nobel Prize winners"
(MH2,151).

Depression is also portrayed as a cost of failed ambition in the
story of a man who was attempting to join a space mission and went
through sixteen rounds of elimination until he finally had to withdraw
because a physical handicap was discovered. This disappointment led to a
serious depression (105). The question of depression is raised with,
arguably, one of the most successful men of our times, former president
Bill Clinton (Paterniti, 2000, p. 2). Clinton talks philosophically
about what leaving the office of one of the most important jobs in the
world is like and makes the point that it can be and has been the
impetus for depression in several previous presidents. "What you
have to do is find what you care about and try to apply yourself to it,
and not just live with your memories. Some presidents including LBJ,
seemed to go through serious and real depressions when they left
office" (Paterniti, p. 2).

The demand to be successful at work and the possibility of economic
or work failure is said to lead to depression in the next quote which
provides the following advice. "Here are some ways to get a grip.
Know your net worth. Know where you're going. Figure out where you
are right now. Charles Dickens summed up a man's relationship to
money thusly, annual income twenty pounds, annual expenditure nineteen
six, result happiness. Annual income twenty pounds, annual expenditure
twenty pounds six. Result misery" (MH4, 158). The quality of
employment is also portrayed as associated with men's depression in
"lack of job security can lead to depressive symptoms that could
last up to 2 years, a recent study found" (104, 74). Part of
men's preoccupation with success is said to be women's
expectations as the next quote indicates. "The bottom-line
findings: David Buss Ph.D, University of Texas surveyed more than 10,000
men and women in 37 cultures around the world" and found that on
average women "prefer men with money, resources, power and
status"(MH2,153).

Violence

Another theme that is less prevalent, but still important, is
violence. The following quote reflects a violent metaphor for the
treatment of depression. "Face it. There are men out there tougher
than you who are threatening to break the kneecaps of their problems. Is
it a coincidence that they are also big and strong enough to break a
real set of kneecaps? I don't think so" (MH1,98). Several men
were described in the light of personal violence including suicide and
self-harm. Note the next two examples. "Demetrius Underwood knifed
himself in the neck" (SI3, 76). "He didn't just beat his
wife, he also beat his oldest child Brittany, breaking her nose twice.
Andy tried and failed to kill himself with car exhaust. Finally Cory
shot his father when he was attacked by him and was attacking his
mother" (SI6, 80).

Discussion

The magazine portrayal emphasizes that men are not to have
feelings, particularly negative feelings. They are not to seek insight
into or help for emotional pain through psychotherapy. They are to be
highly successful in work or sport, even celebrated, and then and only
then to be, incongruously, hit with a powerful biologically generated
"disease" depression. Depression once acknowledged is to be
treated actively and aggressively with anti-depressant medications
prescribed by a doctor. Men's experiences are contrasted with those
of women. Women are described, usually by inference, as both weak and as
"using" men through their demands that they be highly
successful at work and financially. Men are described as engaging in
violent behaviours when depressed.

For men to acknowledge depression, the present magazine portrayal
seems to suggest, they have to repudiate their claims to hegemonic
masculinity, which "is primarily characterized by relations of
domination, actively performed through competition, aggression, bodily
strength, stoicism, heterosexism, homophobia and misogyny" (Gray,
Fitch, Fergus, Mykhalovskiy, & Church, 2002). Illness of any sort,
but particularly an emotional or mental illness, that prevents the
display of these characteristics of hegemonic masculinity especially
aggression, competition and stoicism, is likely a potential threat to
the mental health of men.

These findings also reflect the values of hegemonic masculinity in
regard to the focus on individual achievement and competition in the
portrayal of depression in men. All of the stories about depression
focus on individuals. Virtually all of the individuals are very
successful in work or sports. In anonymous references to depressed men,
CEOs and Nobel Prize winners are deployed as "the type" of men
who get depressed. This representation ignores the empirical reality
that depression has been found to be negatively linked to social and
economic position. Men who are poorer, lack stable and meaningful
employment and social power are more likely to experience depression
(Chen, Subramanian, Acevedo-Garcia, & Kawchi, 2005). As a result of
the emphases in these stories men who are less successful, may not be
able to see their experiences of sadness, anger and frustration as
emblematic of a condition that can be treated. One of the manifest
messages of the media linking of depression with great success in work
and sports is the message that depression can happen to
"anyone" even those presumably most admired by men, the
"rich and famous." Paradoxically, the latent message implicit
in such ideas may be that depression wouldn't happen to most of the
readers who are, after all, not likely to be unusually successful. Thus
ironically this representation emphasizes the differences between most
men and those who get depressed.

Focus on the individual who is depressed also directs attention
away from the possible social precursors or collective preventive
actions that might minimize the later occurrence of depressed, angry or
other unwanted mood. For example, there is no attention paid to the
possibility of prevention through social support, economic and political
equality or learning how to express all feelings, both positive and
negative in a constructive manner that may serve to enhance individual
self-esteem and ability to cope with the everyday challenges of life.

Celebrity, another aspect of individualism, is emphasized in
stories about depression. As well as stories about sports heroes and
even US presidents, there are frequent references to unnamed CEOs and
Nobel Prize winners. This serves two, somewhat contradictory, purposes
at the same time. On the one hand, it distances the reader from the
possibility of identifying with the profiled person and yet
paradoxically it holds the person up for emulation and modeling.
Contrasting messages are implicit. You are both to strive to look and
act like this famous person and you can't possibly be as successful
at work or in sports. Such contradictory presentations may reinforce
personal dissatisfaction and an unwillingness to take action in the face
of suffering.

This research also documents the medicalization of male health or
the "discovery" of the widely expanding medical
"problems" in men. Alongside the development of
pharmaceuticals designed to alleviate male impotence, ADHD, and
baldness, is this another example of the medicalization of "lack
of" masculinity. The findings presented in this research reinforce
the medical model of emotional expression through the emphasis on
treating what is called a real disease through pharmaceuticals and thus
underscore the medicalization of men and masculinity (Rosenfeld &
Fairclough, 2006).

Limitations of the Study

There are a number of limitations to this study. It was
exploratory. We have investigated one sort of medium only-magazines,
over a short period of time. Further research should include a larger
sample of magazines and more articles over a longer period of time.
Other media including television, music, newspapers and movies may have
different representation of depression amongst men. In addition, a
significant proportion of the population is not literate and thus not
directly impacted by mass print media. Thus studies of other mass media
are imperative. In addition, this paper is qualitative and the product
of one researcher's analysis and it is likely that different
readers and researchers would see some different themes.

DOI: 10.3149/jmh.0803.202

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